=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336056381
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | LINDSAY NICOLE JERVIK CNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/25/2026
-----------------------------------------------------
Last Update Date | 08/25/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 W 69TH ST STE 100
-----------------------------------------------------
City | SIOUX FALLS
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57108-2424
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-336-0635
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 29696 480TH AVE
-----------------------------------------------------
City | HUDSON
-----------------------------------------------------
State | SD
-----------------------------------------------------
Zip | 57034-6513
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 605-336-0635
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | 201641
-----------------------------------------------------
License Number State | SD
-----------------------------------------------------